| NPI | 1629011515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DC PSY571) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD PSY02982) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2007-07-09 |